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Morbidity using subcutaneous ports and efficacy of vancomycin flushing in cancer
An evaluation of totally implanted venous access systems inserted in 163 consecutive children with cancer is reported. From 1988 to 1994, 180 subcutaneous ports were inserted in children more than 1 year old.Initial diagnosis was acute leukaemia (n=79), non-Hodgkin's lymphoma (n=33), and solid tumour (n=51). Median age was 85 months. All venous procedures were performed through the device. Chemotherapy was either moderate (n=13) or intensive (n=119) or very intensive (n=48), including 16 patients undergoing marrow transplantation. Cumulative venous access totalled 55770 patient days with a mean of 305 days/subcutaneous port. The cause of device removal was, end of treatment (n=111), death due to malignancy (n=20), catheter related infection (n=7), and occlusion of the system (n=4). Mechanical complications occurred in 19 ports; 16 were due to clots, of which 14 were cleared with instillation of urokinase. Documented infectious episodes occurred in 47 ports, recurred once in 14, and twice in five cases. Among these infections, 47 were septicaemic; 31 due to Staphylococus epidermidis. Twenty seven of initial septic episodes were considered to be catheter related; the rate was 15%/subcutaneous port or 0.05/100 catheter days. Risk factors for the development of a first infection were age below 4 years and the time of use. Since February 1993, vancomycin (50 μg/ml) has been given and this has reduced the rate of S epidermidis infection from 26/83 subcutaneous port to 4/97. Life t
PMID : 7763065 ISSN : 0003-9888 CODEN : ADCHAK
Archives of disease in childhood A. 1995, vol. 72, n° 4, pp. 325-329 [bibl. : 20 ref.]
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